Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c
Authors: Bin Zhou, Kate E. Sheffer, James E. Bennett, Edward W. Gregg, Goodarz Danaei, Rosie K. Singleton, Jonathan E. Shaw, Anu Mishra, Victor P. F. Lhoste, Rodrigo M. Carrillo-Larco, Andre P. Kengne, Nowell H. Phelps, Rachel A. Heap, Archie W. Rayner, Gretchen A. Stevens, Chris J. Paciorek, Leanne M. Riley, Melanie J. Cowan, Stefan Savin, Stephen Vander Hoorn, Yuan Lu, Meda E. Pavkov, Giuseppina Imperatore, Carlos A. Aguilar-Salinas, Noor Ani Ahmad, Ranjit Mohan Anjana, Kairat Davletov, Farshad Farzadfar, Clicerio González-Villalpando, Young-Ho Khang, Hyeon Chang Kim, Tiina Laatikainen, Avula Laxmaiah, Jean Claude N. Mbanya, K. M. Venkat Narayan, Ambady Ramachandran, Alisha N. Wade, Tomasz Zdrojewski, Mohsen Abbasi-Kangevari, Hanan F. Abdul Rahim, Niveen M. Abu-Rmeileh, Shalkar Adambekov, Robert J. Adams, Wichai Aekplakorn, Imelda A. Agdeppa, Javad Aghazadeh-Attari, Charles Agyemang, Ali Ahmadi, Naser Ahmadi, Nastaran Ahmadi, Soheir H. Ahmed, Kamel Ajlouni, Halima Al-Hinai, Badreya Al-Lahou, Jawad A. Al-Lawati, Deena Al Asfoor, Nawal M. Al Qaoud, Monira Alarouj, Fadia AlBuhairan, Shahla AlDhukair, Maryam A. Aldwairji, Mohamed M. Ali, Farbod Alinezhad, Abdullah Alkandari, Husam F. Alomirah, Eman Aly, Deepak N. Amarapurkar, Lars Bo Andersen, Sigmund A. Anderssen, Dolores S. Andrade, Alireza Ansari-Moghaddam, Hajer Aounallah-Skhiri, Tahir Aris, Nimmathota Arlappa, Krishna K. Aryal, Felix K. Assah, Batyrbek Assembekov, Juha Auvinen, Mária Avdičová, Kishwar Azad, Mohsen Azimi-Nezhad, Fereidoun Azizi, Flora Bacopoulou, Nagalla Balakrishna, Mohamed Bamoshmoosh, Maciej Banach, Piotr Bandosz, José R. Banegas, Carlo M. Barbagallo, Alberto Barceló, Maja Baretić, Lena Barrera, Abdul Basit, Anwar M. Batieha, Aline P. Batista, Louise A. Baur, Antonisamy Belavendra, Habiba Ben Romdhane, Mikhail Benet, Salim Berkinbayev, Antonio Bernabe-Ortiz, Ximena Berrios Carrasola, Heloísa Bettiol, Augustin F. Beybey, Santosh K. Bhargava, Elysée Claude Bika Lele, Mukharram M. Bikbov, Bihungum Bista, Peter Bjerregaard, Espen Bjertness, Marius B. Bjertness, Cecilia Björkelund, Katia V. Bloch, Anneke Blokstra, Simona Bo, Martin Bobak, Jose G. Boggia, Marialaura Bonaccio, Alice Bonilla-Vargas, Herman Borghs, Pascal Bovet, Imperia Brajkovich, Hermann Brenner, Lizzy M. Brewster, Garry R. Brian, Yajaira Briceño, Miguel Brito, Anna Bugge, Frank Buntinx, Antonio Cabrera de León, Roberta B. Caixeta, Günay Can, Ana Paula C. Cândido, Mario V. Capanzana, Naděžda Čapková, Eduardo Capuano, Rocco Capuano, Vincenzo Capuano, Viviane C. Cardoso, Axel C. Carlsson, Felipe F. Casanueva, Laura Censi, Marvin Cervantes‐Loaiza, Parinya Chamnan, Snehalatha Chamukuttan, Queenie Chan, Fadi J. Charchar, Nish Chaturvedi, Huashuai Chen, Bahman Cheraghian, María-Dolores Chirlaque, Jerzy Chudek, Renata Cifkova, Massimo Cirillo, Frank Claessens, Emmanuel Cohen, Hans Concin, Cyrus Cooper, Simona Costanzo, Chris Cowell, Ana B. Crujeiras, Juan J. Cruz, Felipe V. Cureau, Sarah Cuschieri, Graziella D’Arrigo, Eleonora d’Orsi, Jean Dallongeville, Albertino Damasceno, Saeed Dastgiri, Amalia De Curtis, Giovanni de Gaetano, Stefaan De Henauw, Mohan Deepa, Vincent DeGennaro, Stefaan Demarest, Elaine Dennison, Valérie Deschamps, Meghnath Dhimal, Zivka Dika, Shirin Djalalinia, Chiara Donfrancesco, Guanghui Dong, Maria Dorobantu, Marcus Dörr, Nico Dragano, Wojciech Drygas, Yong Du, Charmaine A. Duante, Priscilla Duboz, Anar Dushpanova, Elzbieta Dziankowska-Zaborszczyk, Narges Ebrahimi, Ricky Eddie, Ebrahim Eftekhar, Vasiliki Efthymiou, Eruke E. Egbagbe, Sareh Eghtesad, Mohammad El-Khateeb, Jalila El Ati, Denise Eldemire-Shearer, Roberto Elosua, Ofem Enang, Rajiv T. Erasmus, Raimund Erbel, Cihangir Erem, Gul Ergor, Louise Eriksen, Johan G. Eriksson, Ali Esmaeili, Roger G. Evans, Ildar Fakhradiyev, Caroline H. Fall, Elnaz Faramarzi, Mojtaba Farjam, Yosef Farzi, Mohammad Reza Fattahi, Asher Fawwad, Francisco J. Felix-Redondo, Trevor S. Ferguson, Daniel Fernández-Bergés, Marika Ferrari, Catterina Ferreccio, Haroldo S. Ferreira, Eldridge Ferrer, Edith J. M. Feskens, David Flood, Maria Forsner, Sandrine Fosse, Edward F. Fottrell, Heba M. Fouad, Damian K. Francis, Guillermo Frontera, Takuro Furusawa, Zbigniew Gaciong, Sarah P. Garnett, Magda Gasull, Andrea Gazzinelli, Ulrike Gehring, Ebrahim Ghaderi, Seyyed-Hadi Ghamari, Ali Ghanbari, Erfan Ghasemi, Oana-Florentina Gheorghe-Fronea, Anup Ghimire, Alessandro Gialluisi, Simona Giampaoli, Francesco Gianfagna, Tiffany K. Gill, Glen Gironella, Aleksander Giwercman, David Goltzman, Aleksandra Gomula, Helen Gonçalves, Mauer Gonçalves, David A. Gonzalez-Chica, Marcela Gonzalez-Gross, Juan P. González-Rivas, María-Elena González-Villalpando, Angel R. Gonzalez, Frederic Gottrand, Dušan Grafnetter, Tomasz Grodzicki, Anders Grøntved, Ramiro Guerrero, Unjali P. Gujral, Rajeev Gupta, Laura Gutierrez, Xinyi Gwee, Rosa Haghshenas, Hamid Hakimi, Ian R. Hambleton, Behrooz Hamzeh, Willem A. Hanekom, Dominique Hange, Sari Hantunen, Jie Hao, Rachakulla Hari Kumar, Javad Harooni, Seyed Mohammad Hashemi-Shahri, Jun Hata, Christin Heidemann, Rafael dos Santos Henrique, Sauli Herrala, Karl-Heinz Herzig, Ramin Heshmat, Sai Yin Ho, Michelle Holdsworth, Reza Homayounfar, Wilma M. Hopman, Andrea R. V. R. Horimoto, Claudia Hormiga, Bernardo L. Horta, Leila Houti, Christina Howitt, Thein Thein Htay, Aung Soe Htet, Maung Maung Than Htike, José María Huerta, Ilpo Tapani Huhtaniemi, Martijn Huisman, Abdullatif Husseini, Inge Huybrechts, Licia Iacoviello, Ellina M. Iakupova, Anna G. Iannone, Norazizah Ibrahim Wong, Chinwuba Ijoma, Vilma E. Irazola, Takafumi Ishida, Godsent C. Isiguzo, Sheikh Mohammed Shariful Islam, Duygu Islek, Till Ittermann, Masanori Iwasaki, Tuija Jääskeläinen, Jeremy M. Jacobs, Hashem Y. Jaddou, Michel Jadoul, Bakary Jallow, Kenneth James, Kazi M. Jamil, Edward Janus, Marjo-Riitta Jarvelin, Grazyna Jasienska, Ana Jelaković, Bojan Jelaković, Garry Jennings, Anjani Kumar Jha, Ramon O. Jimenez, Karl-Heinz Jöckel, Jari J. Jokelainen, Jost B. Jonas, Pradeep Joshi, Josipa Josipović, Farahnaz Joukar, Jacek Jóźwiak, Anthony Kafatos, Eero O. Kajantie, Zhanna Kalmatayeva, Khem B. Karki, Marzieh Katibeh, Jussi Kauhanen, Gyulli M. Kazakbaeva, François F. Kaze, Calvin Ke, Sirkka Keinänen-Kiukaanniemi, Roya Kelishadi, Maryam Keramati, Mathilde Kersting, Yousef Saleh Khader, Arsalan Khaledifar, Davood Khalili, Bahareh Kheiri, Motahareh Kheradmand, Alireza Khosravi, Ursula Kiechl-Kohlendorfer, Sophia J. Kiechl, Stefan Kiechl, Andrew Kingston, Heidi Klakk, Jana Klanova, Michael Knoflach, Patrick Kolsteren, Jürgen König, Raija Korpelainen, Paul Korrovits, Jelena Kos, Seppo Koskinen, Sudhir Kowlessur, Slawomir Koziel, Susi Kriemler, Peter Lund Kristensen, Daan Kromhout, Ruzena Kubinova, Urho M. Kujala, Mukhtar Kulimbet, Pawel Kurjata, Catherine Kyobutungi, Quang Ngoc La, Demetre Labadarios, Carl Lachat, Youcef Laid, Lachmie Lall, Tiina Lankila, Vera Lanska, Georg Lappas, Bagher Larijani, Tint Swe Latt, Martino Laurenzi, Nils Lehmann, Terho Lehtimäki, Daniel Lemogoum, Gabriel M. Leung, Yanping Li, M. Fernanda Lima-Costa, Hsien-Ho Lin, Lars Lind, Lauren Lissner, Xiaotian Liu, Esther Lopez-Garcia, Tania Lopez, José Eugenio Lozano, Dalia Luksiene, Annamari Lundqvist, Nuno Lunet, Michala Lustigová, George L. L. Machado-Coelho, Aristides M. Machado-Rodrigues, Enguerran Macia, Luisa M. Macieira, Ahmed A. Madar, Gladys E. Maestre, Stefania Maggi, Dianna J. Magliano, Emmanuella Magriplis, Gowri Mahasampath, Bernard Maire, Marcia Makdisse, Mohammad-Reza Malekpour, Fatemeh Malekzadeh, Reza Malekzadeh, Kodavanti Mallikharjuna Rao, Sofia Malyutina, Lynell V. Maniego, Yannis Manios, Masimango Imani Mannix, Fariborz Mansour-Ghanaei, Enzo Manzato, Paula Margozzini, Joany Mariño, Larissa Pruner Marques, Reynaldo Martorell, Luis P. Mascarenhas, Masoud Masinaei, Ellisiv B. Mathiesen, Tandi E. Matsha, Anselmo J. Mc Donald Posso, Shelly R. McFarlane, Stephen T. McGarvey, Sounnia Mediene Benchekor, Kirsten Mehlig, Amir Houshang Mehrparvar, Jesus D. Melgarejo, Fabián Méndez, Ana Maria B. Menezes, Alibek Mereke, Indrapal I. Meshram, Diane T. Meto, Cláudia S. Minderico, G. K. Mini, Juan Francisco Miquel, J. Jaime Miranda, Mohammad Reza Mirjalili, Pietro A. Modesti, Sahar Saeedi Moghaddam, Mostafa K. Mohamed, Kazem Mohammad, Mohammad Reza Mohammadi, Zahra Mohammadi, Noushin Mohammadifard, Reza Mohammadpourhodki, Viswanathan Mohan, Muhammad Fadhli Mohd Yusoff, Iraj Mohebbi, Niels C. Møller, Dénes Molnár, Amirabbas Momenan, Charles K. Mondo, Roger A. Montenegro Mendoza, Eric Monterrubio-Flores, Mahmood Moosazadeh, Farhad Moradpour, Alain Morejon, Luis A. Moreno, Karen Morgan, Suzanne N. Morin, Alireza Moslem, Mildrey Mosquera, Malgorzata Mossakowska, Aya Mostafa, Seyed-Ali Mostafavi, Mohammad Esmaeel Motlagh, Jorge Motta, Kelias P. Msyamboza, Thet Thet Mu, Maria L. Muiesan, Jaakko Mursu, Kamarul Imran Musa, Norlaila Mustafa, Muel Telo M. C. Muyer, Iraj Nabipour, Gabriele Nagel, Balkish M. Naidu, Farid Najafi, Jana Námešná, Vinay B. Nangia, Take Naseri, Nareemarn Neelapaichit, Azim Nejatizadeh, Ilona Nenko, Flavio Nervi, Tze Pin Ng, Chung T. Nguyen, Quang Ngoc Nguyen, Michael Y. Ni, Peng Nie, Ramfis E. Nieto-Martínez, Toshiharu Ninomiya, Marianna Noale, Oscar A. Noboa, Davide Noto, Mohannad Al Nsour, Irfan Nuhoğlu, Terence W. O’Neill, Augustine N. Odili, Kyungwon Oh, Ryutaro Ohtsuka, Mohd Azahadi Omar, Altan Onat, Sok King Ong, Obinna Onodugo, Pedro Ordunez, Rui Ornelas, Pedro J. Ortiz, Clive Osmond, Afshin Ostovar, Johanna A. Otero, Charlotte B. Ottendahl, Akaninyene Otu, Ellis Owusu-Dabo, Luigi Palmieri, Wen-Harn Pan, Songhomitra Panda-Jonas, Francesco Panza, Mariela Paoli, Suyeon Park, Mahboubeh Parsaeian, Nikhil D. Patel, Raimund Pechlaner, Ivan Pećin, João M. Pedro, Sergio Viana Peixoto, Markku Peltonen, Alexandre C. Pereira, Thaliane Mayara Pessôa dos Prazeres, Niloofar Peykari, Modou Cheyassin Phall, Son Thai Pham, Hiep Hoang Phan, Rafael N. Pichardo, Hynek Pikhart, Aida Pilav, Pavel Piler, Freda Pitakaka, Aleksandra Piwonska, Andreia N. Pizarro, Pedro Plans-Rubió, Silvia Plata, Miquel Porta, Anil Poudyal, Farhad Pourfarzi, Akram Pourshams, Hossein Poustchi, Rajendra Pradeepa, Rui Providencia, Jardena J. Puder, Solie Puhakka, Margus Punab, Mostafa Qorbani, Hedley K. Quintana, Tran Quoc Bao, Salar Rahimikazerooni, Olli Raitakari, Manuel Ramirez-Zea, Jacqueline Ramke, Rafel Ramos, Lekhraj Rampal, Sanjay Rampal, Daniel A. Rangel Reina, Mohammad-Mahdi Rashidi, Josep Redon, Jane D. P. Renner, Cézane P. Reuter, Luis Revilla, Negar Rezaei, Abbas Rezaianzadeh, Fernando Rigo, Reina G. Roa, Louise Robinson, Fernando Rodríguez-Artalejo, María del Cristo Rodriguez-Perez, Laura A. Rodríguez-Villamizar, Andrea Y. Rodríguez, Ulla Roggenbuck, Peter Rohloff, Elisabetta L. Romeo, Annika Rosengren, Adolfo Rubinstein, Petra Rust, Marcin Rutkowski, Hamideh Sabbaghi, Harshpal S. Sachdev, Alireza Sadjadi, Ali Reza Safarpour, Sare Safi, Saeid Safiri, Mohammad Hossien Saghi, Olfa Saidi, Nader Saki, Sanja Šalaj, Benoit Salanave, Jukka T. Salonen, Massimo Salvetti, Jose Sánchez-Abanto, Diana A. Santos, Lèlita C. Santos, Maria Paula Santos, Tamara R. Santos, Jouko L. Saramies, Luis B. Sardinha, Nizal Sarrafzadegan, Kai-Uwe Saum, Mariana Sbaraini, Marcia Scazufca, Beatriz D. Schaan, Christa Scheidt-Nave, Sabine Schipf, Carsten O. Schmidt, Ben Schöttker, Sara Schramm, Sylvain Sebert, Moslem Sedaghattalab, Aye Aye Sein, Sadaf G. Sepanlou, Ronel Sewpaul, Teresa Shamah-Levy, Seyed Morteza Shamshirgaran, Maryam Sharafkhah, Sanjib K. Sharma, Almaz Sharman, Amaneh Shayanrad, Ali Akbar Shayesteh, Hana Shimizu-Furusawa, Rahman Shiri, Namuna Shrestha, Khairil Si-Ramlee, Diego Augusto Santos Silva, Mary Simon, Judith Simons, Leon A. Simons, Michael Sjöström, Jolanta Slowikowska-Hilczer, Przemysław Slusarczyk, Liam Smeeth, Eugène Sobngwi, Stefan Söderberg, Agustinus Soemantri, Reecha Sofat, Vincenzo Solfrizzi, Mohammad Hossein Somi, Aïcha Soumaré, Alfonso Sousa-Poza, Karen Sparrenberger, Jan A. Staessen, Bill Stavreski, Jostein Steene-Johannessen, Peter Stehle, Aryeh D. Stein, Jochanan Stessman, Jakub Stokwiszewski, Karien Stronks, Milton F. Suarez-Ortegón, Phalakorn Suebsamran, Johan Sundström, Paibul Suriyawongpaisal, René Charles Sylva, Moyses Szklo, Abdonas Tamosiunas, Mohammed Rasoul Tarawneh, Carolina B. Tarqui-Mamani, Anne Taylor, Julie Taylor, Tania Tello, K. R. Thankappan, Holger Theobald, Xenophon Theodoridis, Nihal Thomas, Amanda G. Thrift, Erik J. Timmermans, Dwi Hapsari Tjandrarini, Hanna K. Tolonen, Janne S. Tolstrup, Maciej Tomaszewski, Murat Topbas, Laura Torres-Collado, Pierre Traissac, Areti Triantafyllou, John Tuitele, Azaliia M. Tuliakova, Marshall K. Tulloch-Reid, Tomi-Pekka Tuomainen, Evangelia Tzala, Christophe Tzourio, Peter Ueda, Eunice Ugel, Flora A. M. Ukoli, Hanno Ulmer, Hannu M. T. Uusitalo, Gonzalo Valdivia, Bert-Jan van den Born, Johan Van der Heyden, Hoang Van Minh, Lenie van Rossem, Natasja M. Van Schoor, Irene G. M. van Valkengoed, Elisabeth M. van Zutphen, Dirk Vanderschueren, Diego Vanuzzo, Senthil K. Vasan, Tomas Vega, Gustavo Velasquez-Melendez, Roosmarijn Verstraeten, Lucie Viet, Salvador Villalpando, Jesus Vioque, Jyrki K. Virtanen, Bharathi Viswanathan, Ari Voutilainen, Wan Mohamad Wan Bebakar, Wan Nazaimoon Wan Mohamud, Chongjian Wang, Ningli Wang, Qian Wang, Ya Xing Wang, Ying-Wei Wang, S. Goya Wannamethee, Karen Webster-Kerr, Niels Wedderkopp, Wenbin Wei, Leo D. Westbury, Peter H. Whincup, Kurt Widhalm, Indah S. Widyahening, Andrzej Więcek, Rainford J. Wilks, Johann Willeit, Peter Willeit, Tom Wilsgaard, Bogdan Wojtyniak, Andrew Wong, Emily B. Wong, Mark Woodward, Frederick C. Wu, Haiquan Xu, Liang Xu, Nor Azwany Yaacob, Li Yan, Weili Yan, Moein Yoosefi, Akihiro Yoshihara, Novie O. Younger-Coleman, Yu-Ling Yu, Yunjiang Yu, Ahmad Faudzi Yusoff, Ahmad A. Zainuddin, Farhad Zamani, Sabina Zambon, Antonis Zampelas, Ko Ko Zaw, Tajana Zeljkovic Vrkic, Yi Zeng, Zhen-Yu Zhang, Bekbolat Zholdin, Paul Zimmet, Emanuel Zitt, Nada Zoghlami, Julio Zuñiga Cisneros, Majid Ezzati
Journal: Nature Medicine (2023)

Abstract Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29–39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance.